TREATMENT OF EPILEPSY – a new Mobile App

This app, Treatment of Epilepsy, will be useful for all health providers and those in allied health fields involved in the treatment and care of patients with epilepsy.

It was conceived and written by 2 pediatric neurologists practicing at Miami Children’s Hospital in Miami, Florida. It is kept up to date regularly.

Within the app, you can access a searchable list of medications by generic and brand names with information about uses, dosage, formulation, metabolism, level, half-life, monitoring, contraindications, mechanism of action, warnings, side effects, and drug interactions. Also use it to look-up seizure and syndrome classifications, as well as syndrome clinical description and their treatment.

It also has information on the treatment of Status Epilepticus, zoomable photos of EEGs, the Ketogenic Diet, driving regulations around the world, pregnancy and breast feeding issues and other practicable information, which can time consuming to find when needed. In summary, Treatment of Epilepsy Features Include:

• An extensive list of medications with targeted treatment information

• Information on a large variety of epileptic syndromes

• Seizure and syndrome classifications

• A notes feature that allows app users to save personal notes for each medication

• An in-app calculator accessible on every screen

• Guide to the laws for driving with epilepsy by state and countries

• Definitions and treatment information for Status Epilepticus

• Uses, parameters, side effects and more associated with the Ketogenic Diet

• Zoomable EEGs

• Information on epilepsy in relation to pregnancy, breast-feeding, and sports

One Hundred & One Questions On Epilepsy

One Hundred & One Questions & Answers about Epilepsy

GENERAL ISSUES

1- What is Epilepsy?

Epilepsy - derived from the Greek word epilambanein, meaning “to seize” or “to attack”- is a neurological disorder characterized by a tendency for recurrent, unprovoked seizures. These episodes briefly interrupt the normal functions of the brain and are characterized by sudden, abnormal changes in movement, behavior, sensation or consciousness. Since these episodes are called seizures, epilepsy is sometimes called a seizure disorder.

2-What causes epilepsy?

The causes of epilepsy are many; almost any disease that affects the central nervous system is potentially capable of producing epilepsy. Some of the most common causes include head trauma, stroke, brain tumors, cerebral infections, lack of oxygen, and yet some causes are genetic. However, for about half the cases, no specific cause is found.

3-Is epilepsy an inherited condition?

In some cases it is, although it does not happen very often. According to the Epilepsy Foundation, even when both parents have epilepsy, the likelihood of passing on this genetic trait to their children is only between 10% to12%.

4-What age groups are most at risk for epilepsy?

Although epilepsy can occur within any age group, the majority of seizure disorders begin in early childhood or in later life, particularly in the elderly.

5-What causes epileptic seizures?

Epileptic seizures occur when a large group of brain cells called neurons, whose function is to send electrical signals to the different parts of the body, misfire and cause electrical disturbance of variable duration in the brain; thus, affecting the normal function of the parts of the body they are designed to control.

6-What factors trigger epileptic seizures?

Factors such as non-compliance with medication, high fever, massive sleep deprivation, stress, over-exertion, consumption of excessive alcohol or binge drinking and taking recreational drugs, for example cocaine, can make you more likely to have a seizure. Metabolic changes such as changes on sugar level, dehydration, hormonal changes, particularly around the menstrual cycle, environmental factors such as high heat and humidity and flickering lights, may also trigger seizures in people with epilepsy.

7- Can people outgrow epilepsy?

Yes. In many cases, especially the genetic types of epilepsy, children may simply outgrow the seizures as they go through adolescence and puberty. Seizures are unpredictable; they may continue to occur or decrease with time.

8-Can someone with epilepsy obtain and maintain a driver’s license?

In many cases yes, the critical issue is seizure control. Florida, like the majority of states in U.S., has specific guidelines concerning driver’s licensure for individuals with epilepsy. In Florida, the guidelines are that applicants and licensed drivers should be seizure free for at least 6 months, and under medical supervision, to be able to apply for licensing. However, if the individual has been seizure free for a period of two years, he or she can apply for a license without any medical supervision. Contact your local Division of Driver Licenses for more information.

9- Can someone with epilepsy participate in sports and other activities?

Most people with epilepsy want to participate in a wide variety of life’s activities, including sports, exercise and fitness programs. In most cases they can participate in such programs depending on the degree of seizure control. Activities such as mountain climbing, swimming alone, scuba diving, boxing and football are higher risk activities. Always contact your doctor prior to beginning any physical sport or activity in which a brief lapse of consciousness would significantly increase the chance of injury.

10-Does epilepsy affect mental ability?

Lapses of memory and cognitive impairments are two of the most common complaints of persons with epilepsy. The type of seizure and medications may affect these mental functions. If you experience such problems, talk with your doctor.

11-Can people die from epilepsy?

Most people with epilepsy live a full life span. However, there are potential factors associated with living with epilepsy and seizures that may increase the risk of early death. Prolonged seizures or seizures that happen quickly, one after another (called status epilepticus), can be life-threatening. Status epilepticus can sometimes occur when anti-seizure medicine is stopped suddenly. This is a medical emergency and needs immediate medical attention. Some people with epilepsy may die suddenly, without explanation. This is called SUDEP which stands for Sudden Unexplained Death in Epilepsy. SUDEP is not well understood, although it is suspected, sometimes, to be related to heart rhythm problems during a seizure. The risk of sudden death occurs more among people with convulsive seizures, especially generalized tonic-clonic seizures that are not well controlled.

12-Are there any safety precautions I should take at home if my spouse or child has epilepsy?

Most people don’t get hurt when they have a seizure but it can happen. There are many practical steps you can take to minimize your risk for injury in case of seizure. For example, (1) set the thermostat of the water heater low enough to prevent scalding or purchase a scald protection product; (2) pad sharp corners; (3) try a microwave oven for cooking; (4) select chairs with arms to prevent falling; (5) hang bathroom doors so they open outwards instead of inwards (so that if someone falls against the door, it can still be opened); (6) Remove burner controls from gas or electric stoves when not in use.. Ask your local epilepsy provider for more information.

MEDICATIONS & TREATMENTS

14-What is a neurologist?

A neurologist is a specially trained physician who treats diseases and disorders of the nervous system. He or she sees patients who have Alzheimer’s disease, stroke, movement disorders, neuromuscular diseases, memory disorders, brain infections, seizures, and epilepsy among others. An epileptologist is a neurologist who specializes in the treatment of epilepsy.

15-Where can a person get medical care for epilepsy?

Typically, medical care for epilepsy begins with a primary care physician. Many times, the primary care physician may refer you to a neurologist for more specialized care. For those without health insurance, a number of agencies, such as the County Public Health Department may be of assistance. In Florida, contact the Epilepsy Foundation of Florida. In case of medical emergency, dial 911 or the operator.

16-Is there any one-way of diagnosing epilepsy?

The diagnosis is suggested by the seizure history and physical exam. There are a variety of tests available to assist in the diagnosis of epilepsy. Besides the electroencephalograph (EEG), a Magnetic Resonance Imaging (MRI), Computerized Axial Tomography (CT), Positron-Emission Tomography (PET). Scans or long-term video EEG monitoring may be used. Based on the initial consultation, the doctor will select one or more of the diagnostic tests. For the more difficult cases to diagnose, more sophisticated diagnostic tests are available.

17-What is an EEG?

The electroencephalogram or EEG is a very useful tool in the diagnosis of abnormal brain activity. This device measures brain electrical activity through electrodes that are attached to the person’s head. This painless procedure measures different patterns of activity in different parts of the brain. The EEG may indicate the person’s type of epilepsy. The EEG can provide supportive evidence for a person’s epilepsy when coupled with their medical history. However, a routine EEG is often normal in persons with epilepsy.

18-What is long-term EEG monitoring?

Sometimes, when the EEG does not provide the supportive evidence or when the results are inconclusive, the doctor may request an evaluation with a long-term continuous EEG with simultaneous video recording known as telemetry monitoring (usually during a hospital stay of one day to two weeks). Having a correlation of the recorded behavior (video) and the EEG activity, the diagnosis of seizures or non-epileptic attacks can be made definitely in nearly all cases.

19-What is a MRI? A CT Scan?

An MRI or Magnetic Resonance Imaging gives a detailed three-dimensional view or image of the brain. It can help see through the skull, defining structures in the brain. CT or Computerized Axial Tomography uses a computer technology and x-rays to make a computerized image of the brain. Both are imaging devices used to find bleeding, swelling, tumors, scarring, and other anomalies within the brain.

20-What is the best treatment for epilepsy?

There is not one, best treatment for epilepsy. There are, however, a number of treatment options available, including medications, surgery, the ketogenic diet, vagus nerve stimulation, and deep brain stimulation. Currently, new research is being conducted to discover and test innovative ways to inhibit or control seizures.

21-How do medications work?

Anti-convulsants or anti-epileptic drugs work by either inhibiting or exciting the neurons to a normal level of chemical or electrical exchange. They help to prevent neurons from misfiring. The medications do not cure epilepsy but help control seizures and allow a person to regain the ability to live life as normally and confidently as possible.

22-Why do I have to take the medication on time?

Medications must be taken regularly to maintain a sufficient level in the blood stream so that it may control seizure activity with a minimum of side effects. If you do not take the medication on time, your levels may drop (sub-therapeutic) to a point where you do not have enough medication in your system to prevent seizures.

23-What happens if I miss a dose?

It's quite common for people with epilepsy to miss a single dose once in a while. Often nothing bad happens but your chance of having a seizure may be increased. Missing one dose is more likely to cause seizures if you're scheduled to take your medicine only once a day. Then if you miss a dose, you've missed a full day of medication. If you take it two to four times a day, the risk from missing one dose is less. But if you miss several doses in a row, the likelihood of a breakthrough seizure will be higher.

24-Are there side effects to medications?

There are potential side effects from any medication including anti-epileptic medications. The effects vary a great deal from one individual to another. Common side effects are dizziness, drowsiness, lack of energy, nausea, headaches, difficulty concentrating unsteadiness, blurry or double vision. Some major side effects include allergic reactions, anemia, liver failure, and psychiatric reactions among others.

25-Will other prescription medications or over-the-counter drugs have an effect on my epilepsy medications? Or vice-versa?

Any medication, whether prescription or over-the-counter, may have an effect on anti-epileptic medications or vice-versa. Medications that are used to treat allergies, especially the antihistamines have been associated with seizure activity in some patients. Always inform your physician or pharmacist about the medications you are currently taking before taking any new drugs.

26-How many anti-epileptic drugs (AEDS) are there and which one’s best for me?

Since 1990, a number of AEDs have been introduced making more than 30 different medications available for controlling seizures. A consultation with your doctor is required to determine which medication is best for you.

27-What is a therapeutic drug level?

A therapeutic drug level is the amount of medication generally required in the bloodstream for a particular medication to be effective with few or no side effects. Levels serve as guides to assist in treatment when they are available. Some newer drugs do not yet have established ranges nor do they require blood level testing.

28-I’m tired of taking my epilepsy medication (AEDs). Is it okay to stop taking it completely and abruptly? Is it okay to begin decreasing the dosage of medication?

Abrupt cessation of AEDs or decreasing the dosage of your medication is not recommended unless you’re following specific instructions from your doctor. The reason for taking the AEDs is to control the seizure activity. You risk an increased number of seizures or having serious prolonged, and possibly life-threatening, seizures that may put you in the hospital.

29-My anti-epileptic medication is causing side effects. What can I do?

If you are experiencing notable or unwanted side effects due to your medication (such as nausea, rash, etc.), contact your physician and describe your symptoms. Occasionally, by adjusting the dosage, your side effects will decrease or diminish altogether. In other cases, alternative treatments may need to be considered if side effects are intolerable.

30-Is it all right to substitute a generic drug for a name-brand drug?

Many name-brand prescriptions drugs may be substituted with a generic drug at a cost savings that is passed on to the consumer. However, people with epilepsy should always talk to their physician before making such a change as generic medications may induce a change in seizure control or side effect profile.

Sexuality is an important and private aspect of life. People with epilepsy appear to have a higher incidence of sexual dysfunction than persons with other chronic neurologic illnesses. Studies indicate that problems with reduced sexual desire and/or sexual arousal may affect endocrine functions. If you experience sexual dysfunction, consult your physician.

33-Why do I have to have periodic blood tests performed?

AEDs may dissolve at a different rate for each person. Doctors request a blood test to monitor the amount of medication circulating through a person’s system, i.e., to measure how much medication is in the blood stream. For AEDs to work effectively, the medication has to be available throughout the day and in the proper amount for the optimum protection from seizures.

34-What role does sleep have for epilepsy patients?

Persons with epilepsy should strive to maintain consistently good sleep patterns and rest. Sleep deprivation or irregular sleep patterns may trigger seizures in persons with epilepsy.

35-What role does nutrition play in the treatment of epilepsy?

Good nutrition is important for everyone. It is important that persons with epilepsy taking AEDs follow proper nutrition. Proper nutrition allows medications to metabolize properly in the blood stream. Some AEDs may suppress or increase appetite.

36-When is epilepsy treated by surgery? Is it safe?

Epilepsy surgery is used when medications do not help to control a person’s seizures. Neurologists look at a number of criteria. To be a candidate for surgery, a person’s seizures (1) are not responsive to drugs (2) interfere with daily activities and (3) surgery can be performed safely. Surgery for epilepsy is a viable option today for some people. Consult your physician for more information.

37-What is WADA test?

The Wada test is used to assess language and memory functions in persons preparing to undergo surgery for seizures. Wada testing is used prior to epilepsy surgery for predicting the dominant speech hemisphere and memory dysfunction. The test is performed by a neurologist, a neuro-psychologist and a neuro-radiologist.

38-What is a Vagus Nerve Stimulator?

The Vagus Nerve Stimulator is a surgical implanted device that sends a micro-electrical stimulation signal to the vagus nerve. This device may reduce the frequency or severity of seizures in persons with epilepsy. It is now considered a viable treatment option for epilepsy.

39-How does biofeedback treatment for epilepsy work?

Biofeedback can be used to help some people modify their seizures. By using biofeedback, a few persons with epilepsy may be able to shorten seizures or even prevent them from occurring by slowing one type of brain activity, while increasing another.

40-What type of diet is used to treat epilepsy?

The ketogenic diet, a diet low in proteins and carbohydrates and high in fats, is sometimes used in certain childhood epilepsies, including absence, atonic, myoclonic seizures, infantile spasms and Lennox-Gastaut Syndrome. The diet does have some short- term benefits of seizure response or control but most patients have difficulty with compliance. In rare cases, particularly for the children who have had poor seizure control with other methods, your physician may prescribe the ketogenic diet. The diet may change the body chemistry in ways that may have a positive effect on seizure control. A modified, and less strict, version of the ketogenic diet exists called the Modified Atkins Diet. Either of these diets needs to be supervised by a physician or nutritionist.

41-Can vitamins and minerals help in the treatment of epilepsy?

Vitamins and minerals taken as dietary supplements can help with nutritional issues. The use of folate (folic acid) has been shown to reduce the potential for congenital malformation associated with the majority of anticonvulsant drugs. There is, however, no conclusive proof that vitamins and minerals can help reduce the frequency of seizures in persons with epilepsy.

Some metabolic enhancers may interfere with proper utilization of medication for persons with epilepsy. Products claiming to be natural falsely imply that they are safe. If you are considering using an herbal or synthetic supplement, talk to your doctor first.

43-Can stress increase the frequency of seizures?

Although difficult to quantify, stress during activities of daily living appears to increase the frequency of seizures in some people with epilepsy. Stress causes the release of adrenaline hormones that can increase blood circulation and breathing rates. If you can identify stressful situations and avoid them or cope with them, you might reduce the chance of having a seizure. Stress alone does not cause epilepsy.

Seizure Recognition & First Aid

44-How do physicians determine what type of seizure I may have?

The initial diagnosis for epilepsy is often based on information provided by the person with epilepsy, family and friends describing events and behaviors before, during, and after seizures. During the medical consultation, the physician usually obtains a complete medical history, gives you a physical examination and orders diagnostic tests such as EEGs, MRIs, CT Scans, which will help with this diagnosis. If these tests are ineffective with diagnosis, other more sophisticated tests are performed.

45-What is the difference between an epileptic and non-epileptic seizure?

Epileptic seizures are seizures caused by abnormal electrical discharge of the brain. Typically an EEG recording of the electrical activity of the brain will help with diagnosis. Non-epileptic seizures are attacks that are not accompanied by abnormal electrical discharges, and are therefore not epileptic. These seizures do not respond to anti-epileptic treatment.

46-What are pseudo-seizures?

Pseudo-seizure is an older term used to describe a psychological disorder that induces seizures of non-epileptic origin. Most often they are caused by a variety of emotional stress and other psychological and/or physiological. They are physical reactions to psychological stress (psychogenic) and may resemble epileptic seizures, although their causes differ as does their medical treatment.

47-What kinds of seizures do people with epilepsy have?

(see table, page 16)

48-What should you do if someone has an epileptic seizure?

(see table, page 16)

49-Do seizures hurt the brain?

Although some epileptic seizures may momentarily incapacitate persons with epilepsy, there is no medical evidence that a single seizure permanently damages the brain. However, very frequent or very prolonged seizures may cause subtle brain damage leading to the decline of intellectual function.

50-What is Status Epilepticus?

Status Epilepticus is a prolonged seizure or cluster of seizures occurring one after another, where the patient does not regain consciousness between seizures. This is a medical emergency. Call 911 and your physician (see question #11).

51-What is an aura?

An aura is the initial warning for seizures. Some persons with epilepsy frequently describe a strange sensation or feeling just before a complex or secondarily generalized seizure, including dizziness, numbness, nausea, a buzzing in the ear, a metallic taste, a stomach sensation or strong emotions. Auras are actually simple partial seizures. Auras typically occur from a few seconds to minutes prior to the seizure.

52-What are neo-natal seizures?

Neo-natal seizures are seizures that occur during the first four weeks of an infant’s life. Approximately 1% of all newborns will have neo-natal seizures.

53-What is narcolepsy?

Narcolepsy is a syndrome characterized by sudden sleep attacks, cataplexy, sleep paralysis and visual/auditory hallucinations at the onset of sleep. Narcolepsy usually begins in the adolescence or young adulthood. The cause is unknown. Persons with narcolepsy experience an uncontrollable desire to sleep, sometimes, many times in one day. Narcolepsy is unrelated to epilepsy.

WOMEN & CHILDBEARING ISSUES

54-I have epilepsy and I would like to raise a family. Is this a good idea?

It is a good idea for women with epilepsy wanting to raise a family to consult with their neurologist and OB/GYN for family planning prior to pregnancy. Pre-pregnancy counseling is always a good idea. The key is for the mother and child to get proper care before, during, and after pregnancy.

55-How should I plan before getting pregnant?

Because of the number of health issues involved, women with epilepsy should have coordinated health care at least 6 months prior to pregnancy. Women with epilepsy are generally considered high-risk pregnancies. Approximately 25% of women with epilepsy may have increased seizures during pregnancies while the rest of them may experience better seizure control or experience no change at all. It is important for women to see their physician regularly during pregnancy and three to four months postpartum.

56-Is it true that anti-epileptic medications may lessen the effectiveness of my birth control pill?

The effectiveness of birth control pills may indeed be impaired when women take certain AED’s. However, not every anti-convulsant interacts negatively with birth control pills. Your physician may recommend an oral contraceptive with lower estrogen content or suggest alternative control methods or may even change your AED.

57-If there is a history of epilepsy in our family, what are the chances that my child will have it?

There are two issues here. First, if there is a history of non-heredity epilepsy in the family, the chances of the child having epilepsy is about the same as in the general public (1.5%). Second, if there is a history of hereditary epilepsy in the family of one parent, the chances rise to about 5%. If there is a history of hereditary epilepsy in both parents, the chances rise to about 10%. Again, pre-pregnancy counseling is recommended.

58-I have heard that anti-epileptic medications may cause birth defects. Should I stop taking my medication during pregnancy? Should I change my medication?

The birth of a normal baby without birth defects is a primary concern for all parents. Since all drugs present a possible danger to a developing fetus, women with epilepsy taking AEDs share their concerns that medications may pose possible risks to their baby’s development. However, withdrawing medication during pregnancy can cause prolonged seizures. Stopping medication poses a greater risk than the effect of the drugs themselves. With planned conception, your physician will address the risks and treatment options with you. With proper care, more than 90% of women with epilepsy have normal babies.

If you are planning on breast-feeding, it is important to discuss this with your doctor. Most infants do not suffer any harmful effects from traces of AEDs found in breast milk. Although some medications may be found in the mother’s milk, breast-feeding is often acceptable as long as it does not cause any side effects to the baby.

60-Do women have an increase in seizure activity during their menstrual cycle?

Fluctuations in female hormones around the menstrual cycled may elevate seizure frequency in some women. Seizures occurring before, during or after menstruation are known as catamenial seizures.

PEDIATRIC ISSUES

61-What is the frequency of epilepsy in children?

1% of children have some type of epilepsy, though up to 4–5% may experience one or more febrile seizures between the ages of 6 months and 5 years.

62-Are seizures with fever related to epilepsy?

Febrile seizures, or seizures occurring with fever, are seen typically in children from the ages of 6 months to five years and are usually not related to epilepsy. Febrile seizures may occur with childhood illness such as upper respiratory tract infection, measles, mumps, chickenpox or following a vaccination.

63-Do seizures impair the learning process?

Some seizures may impact the learning process. The cause of seizures may also be an issue. Both seizures and the side effects of some AED medications may impair the learning process. Consult your physician for more information.

64-Are there epilepsy medications specifically designed for children?

There are no epilepsy medications specifically designed for children. However, many AEDs, which are effective for adults with epilepsy, are equally effective for children. Dosages may differ and some medications are not recommended for newborns nor infants.

65-Can my child take gymnastics, swimming or dance lessons?

Epilepsy should not preclude children or adults from taking part in most recreational activities and sports. Unless the child is having uncontrolled seizures, participating in any of these activities would add to the child’s quality of life. No one should ever swim alone or participate in any activity where a brief lapse of consciousness would significantly increase the risk of injury.

66-Can my child be involved in contact sports?

Epilepsy should not prevent children from participating in sports but you should review the risks carefully before letting your child take up contact sports. Contact sports could put them in danger if they were suddenly unaware of what they’re doing. Talk to your physician and inform the coaches about your child’s condition.

67-Should I tell my child’s teacher about his/her epilepsy?

Teachers should know if a student has epilepsy. It’s important that you take time to discuss with teachers and school nurses how epilepsy affects your child. The more information you provide about your child’s condition, the better the teacher/nurse will be attuned to your child’s needs. Some parents may wish to conceal their child’s condition particularly if the seizures are well-controlled. Most physicians would agree this would not be in the best interest of the child.

68-Will my child be excluded from any school activities because he or she has seizures?

Individuals with Disabilities Education Act, or IDEA, establishes the child’s right to a free and appropriate education that is not above or below the child’s need. Most children with epilepsy can be included in school activities such as drama, band, sports, field trips, cheerleading, chorus, service clubs, student government and safety patrol even if their seizures are not totally controlled. Physical Education supervision is important if the child has exercise-related seizures. The Rehabilitation Act of 1973, section 504, prohibits discrimination because of disability.

69-What should I do if I feel my child is being discriminated against or is being excluded from school activities because of epilepsy?

A good first measure is to meet with your child’s teacher and/or nurse. If the problem cannot be resolved, meet with the school administrator. If the problem continues, contact your school board representative. Additional resources include the Florida Department of Education, the Epilepsy Foundation, a parent advocacy group such as Parent to Parent, or the Advocacy Center for Persons with Disabilities in Tallahassee, Fl at 1-800-342-0823.

70-How can students and faculty learn more about epilepsy?

A number of resources are available. The Epilepsy Foundation of Florida offers free educational programs for students, faculty and administrators. Your school nurse may also be available to provide education. Information is also available at www.EpilepsyFLA.org.

71-Does the school have to call an ambulance each time my child has a seizure in the classroom?

No, providing the teacher and the school staff with information about epilepsy helps them to know what to do when a seizure occurs. Such information may decrease unnecessary trips to the hospital. An ambulance should always be called in the event of a prolonged seizure lasting five minutes or more or if an injury occurs.

72-Can my child receive special consideration at school due to his seizures?

Yes, depending on the type of seizures and seizure frequency. Your child may be eligible for a number of special services, accommodations and modifications or financial assistance. Check with your child’s school to access these services.

73-Can seizures go away with the onset of puberty and adolescence?

No one can accurately predict when seizures will go away. However, some children will stop having seizures during adolescence and puberty. Some types of epilepsies are often outgrown.

74-Can my child go off to college and live a normal life?

Yes, most teens and young adults with epilepsy will be able to live normal lives. For some this may mean going off to college. These students may face additional hurdles. This will be the first time they are away from home and responsible for their own medication, health care and diet. A realistic, optimistic and flexible attitude on the part of parents is most encouraging for the student.

75-Can family problems affect the frequency of seizures in my child?

Yes, family problems can cause stress in a child. Stress can lower the threshold for seizures.

76-My daughter does not like to eat breakfast in the morning. Can this alter the effectiveness of her anti-epileptic medications?

Yes, proper nutrition is important for persons with epilepsy taking AEDs. Some AEDs are prescribed to be taken with meals, including breakfast.

77-My relatives will be visiting soon. Should I tell them my child has epilepsy?

Not necessarily. If your child’s seizures are under good control, you may want to tell only your immediately family and closest friends or those involved in your child’s care. By being straightforward about epilepsy, however, you’ll decrease some of the myths and stigmas about the disorder.

78-My rebellious teenager is now refusing to take his medication. Is this common?

The teen years can be difficult for both parents and teens with epilepsy. Sometimes as a way of showing their independence or because of social pressure from peers, teens may stop taking their AEDs, or start using alcohol or drugs. As a result, seizure control may suffer. A way of preventing this is by having open communication between parents and teens.

79-My child recently witnessed his mother having a seizure and is now scared. What can we do to put him at ease?

The child’s age will dictate how and what you will tell him about his mother’s condition. Be honest and explain as unemotionally as possible what happens during a seizure and how the child will be able to help. You may also wish to contact the Epilepsy Foundation of Florida for family education and educational resources.

80-How do I tell my child I have epilepsy?

Many parents do not disclose their epilepsy to their children, fearing their children will react negatively. It’s best to tell children about your epilepsy before they witness a seizure. Explain to them what epilepsy is, what happens during a seizure, how they can help, and why you take medication. You may also wish to contact you’re the Epilepsy Foundation of Florida for family education and educational resources.

81-What is a Benign Rolandic Epilepsy?

Benign Rolandic Epilepsy, the most frequent of benign partial epilepsies of childhood, typically presents as nocturnal seizures that do not result in any neurological or intellectual deficits. The categorization of this syndrome as benign refers to the tendency for the seizures to remit over time. In some cases, the patient may not need to be medicated.

82-What is Lennox-Gastaut Syndrome?

Lennox-Gastaut Syndrome is a severe form of epilepsy with seizures usually beginning before 4 years of age. The types of seizures presented vary but they are frequently resistant to anti-epileptic medications. It is frequently associated with developmental delay and mental retardation and is one of the most difficult epilepsy syndromes to treat.

SENIORS

83-Can strokes cause epilepsy?

Yes. Stroke is the most frequent cause of seizures in seniors. Because arteries may become clogged or narrowed as people age, the brain may be deprived of blood and oxygen. The result may be a stroke. Bleeding in the brain may also result in seizures.

84-Does epilepsy worsen with age?

It is known that as we age, our bodies begin a natural and physiological deterioration process that can make epilepsy more likely to occur. Other health problems associated with epilepsy (including brain tumors,heart disease, high blood pressure, depression, mental alertness, and increased sensitivity to medications) may also contribute to the difficulty of treating epilepsy in seniors.

85-Can the aging process affect the way the medication works?

Yes, aging along with other health issues can affect the way medication is metabolized. That is why it is important for seniors to have frequent neurological check-ups. Sometimes lower doses may be required.

86-Are seniors more sensitive to the depressive aspects of a drug or combination of drugs?

Yes, especially when they are taking a combination of medications that may lead to altered mood or changed behavior. Some medications may negatively interact or change the effect of other drugs.

87-If I’m having side effects due to my medication, can I just stop taking it?

No, you should never stop taking an AED abruptly without first consulting your physician. To do so might raise your risk for increased seizures.

88-I’m 72 years old and I am taking medication for a number of health problems in addition to my epilepsy medication. Is this a problem?

Taking a number of medications daily may be hard to track. They may have negative side effects or reduce the effectiveness of other prescribed drugs. If you are seeing various specialists, be sure each knows what prescriptions you are taking.

89-Are adult living facilities, or nursing homes, and their staff capable of caring for someone with epilepsy?

Most adult living facilities and nursing homes are licensed and approved to care for persons with epilepsy and other health conditions.

90-My father, who has epilepsy, has been injured at home numerous times during seizure activity. Is there anything that can be done to prevent these injuries?

Having someone available to take care of your elderly father at home is one solution. Other alternatives include having family members and neighbors periodically stop by to check on him; carpeting floors; using padded furniture; clearing trip hazards; and using electronic tracking or motion devices and other technology. You may also contact trained professionals who can provide help in these areas, including occupational and rehabilitation specialists.

91-Is treatment of epilepsy different now than 40 years ago?

Yes. There have been many advances in the field of epilepsy care during the last 40 years, including new medications, surgical options and techniques, implantable electronic devices, diagnostic testing, and a better understanding of how the brain works.

PSYCHOSOCIAL & EMPLOYMENT ISSUES

92-Since my husband was diagnosed with epilepsy, he has gone through periods of depression and anger. Is this normal?

Yes, it is. Many epilepsy patients go through periods of denial, anger and depression after receiving the diagnosis of epilepsy. Most, through time and counseling, will learn to cope with feelings and lead productive lives once again. However, researchers have noted a higher incidence of depression among patients with epilepsy than the general population or others with chronic conditions such as diabetes. Patients with epilepsy usually respond well to anti-depression medication and with lower doses.

93-What can I do to get the best out of my visits to the doctor?

Come prepared. Be honest with your physician about how you feel physically, mentally, and socially and report any seizure you have had since your last visit. Keep an accurate seizure calendar and bring a list of all the medications (and dosages) you are taking. Prepare questions prior to the consultation. Learn as much as you can about epilepsy and its treatment. Good open communication between physician and patient is a must in the treatment of epilepsy. Bringing a caregiver, relative or friend to the medical visits can enhance the accuracy of what you report and learn from the doctor.

94-Why should I need a neuro-psychological evaluation?

The neuro-psychological evaluation is used to measure such things as cognitive impairment, short and long-term memory deficits, mood, behavior, personality, and other functions in persons with epilepsy. It also measures how the quality of life in these persons has been affected.

95-Where can I find support groups to help our family to cope with epilepsy?

The Epilepsy Foundation of Florida offers support groups. Other possibilities include contacting your local United Way or your physician.

96-Can a person with epilepsy be employed?

Yes, people with epilepsy can do most jobs depending on the quality of their seizure control. The unemployment rate for people with epilepsy is significantly higher than that of the general population, and many people who do work are underemployed. One study shows that persons with a seizure disorder have better safety and productivity records than other workers. However, the employee with epilepsy should keep risks at the minimum (operating heavy machinery, working with heights, driving, etc.).

97-Do I have to tell my employer that I have epilepsy?

Not necessarily, although it may be a good idea. It may be best to tell your employer if your seizures are not fully controlled. Providing them with information will enable them to help you if a seizure occurs and help them better understand your medical condition. You do not have to tell employers during the interview process unless the issue is addressed, e.g., through driving restrictions. The ADA was passed to protect employees who have a disability. The Epilepsy Foundation of Florida can provide you with additional information on disclosure of epilepsy in the workplace.

98-Do people with epilepsy who are employed miss more days off from work than their coworkers?

Studies show that most employees with epilepsy have good attendance records and that workplace accidents are no more frequent in employees with epilepsy than other employees.

99-Can I obtain health insurance if I have epilepsy?

If you work with a company that offers an employee health group plan, you can obtain insurance. There will probably be a one-year to eighteen month pre-existing clause for epilepsy though that is subject to change soon with the passing of the Health Care Reform Plan. Otherwise, it will be more difficult to obtain insurance. You will need to contact insurance companies for information about price and coverage.

100-What can I do if I feel I have been discriminated against in a workplace?

Always try to resolve this matter first with your employer. If this does not meet your satisfaction, you may call the Epilepsy Foundation of Florida or the Equal Employment Opportunity Commission office for assistance. The national Epilepsy Foundation may have a list of attorneys willing to assist you on a pro bono basis.

101-Can I file a disability claim if I have epilepsy?

If you’re following a regular medical treatment and your seizures remain uncontrolled, Epilepsy Disability claims may be filed through the office of Social Security. Talk to your doctor and contact your local Social Security office for information regarding this process.

Transportation

Transportation can present a daily challenge for people with epilepsy. People with epilepsy may not be able to drive or may have restricted licenses, making it difficult getting to necessary places. Not driving may limit the ability to work or attend school, to socialize or participate in community events, or get to medical or other important appointments. While public transportation may be an option for some, it may not be an appropriate or accessible option for others. Below are various transportation options:

Transportation Services For Persons With Disabilities

The University of Florida’s Institute for Mobility, Activity and Participation has,with funding from the Florida Department of Transportation developed the Florida Senior Safety Resource Center (FSSRC), created a database containing over 800 transportation services. This up to date and user directed information for seniors, or persons with disabilities, addresses the need to find appropriate, acceptable and affordable alternative transportation options within their local communities. These services range from highly organized to very flexible and provide various levels of assistance, throughout all of Florida’s 67 counties. To view the alternative transportation options that are available in a specific county, go to http://www.SafeandMobileSeniors.org/FindARide.htm and click on the county name, it is that easy!

Public Transportation

Availability of public transportation and related assistance varies by county. For example, in Miami Dade, you can visit www.miamidade.gov/transit/fares_golden.asp to see what initiatives are available for people with disabilities.

Paratransit Services

As noted above, public transportation may not always be accessible or appropriate for people with seizure disorders. For people with frequent seizures, it may be dangerous to wait for regular bus services at busy intersections where they may encounter danger during a seizure. Paratransit services are transportation services for people who cannot use the regular public transportation bus services. These services may pick people up at their homes or at specific locations. Paratransit services may be available for people who meet one of the following requirements:

You cannot get on, ride on, or get off a regular bus because of your disability even when the bus is accessible; or

You have a disability and can't use the regular bus system; or

Your impairment prevents you from traveling to or from a bus stop.

To find out about paratransit services, contact the county transit authority where you live. When applying, people should specifically describe their disability or impairment in detail and explain why their condition prevents them from using the regular bus system. Notes from doctors may be helpful to support the information provided in the application. For example, in Miami-Dade, you can visit www.miamidade.gov/transit/rider_sts.asp to learn more about the Special Transportation Service.

Driving

Can you drive an automobile if you have epilepsy? Yes, if your seizures are controlled with treatment and you meet the licensing requirements in your state. Every state regulates the driver's license eligibility of persons with certain medical conditions. The most common requirement for people with epilepsy is that they be seizure free for a specified period of time and submit a physician's evaluation of their ability to drive safely. Another common requirement is the periodic submission of medical reports, in some states for a specified period of time and in others for as long as the person remains licensed. Click on the link below to read the requirements and information regarding driving in Florida or any other state